Breathe life into quality, satisfaction studies
July 1, 1998
Breathe life into quality, satisfaction studies
At your last accreditation survey, the surveyors said your quality studies needed new life. They said the patient satisfaction survey you've been using for five years, which brought "excellent" and "very good" ratings from more than 90% of patients, needs to be completely revamped.
On top of all this, your lengths of stay and turnover times have been reduced so much you have difficulty squeezing in education before surgeries. At the same time, your patients increasingly have questions related to the information - and misinformation -they receive about their procedures from the Internet.
How can a same-day surgery manager provide adequate patient education, conduct meaningful quality improvement studies, and keep patients, surveyors, and payers happy? Sound like an impossible task? Read on.
To assist same-day surgery managers who are being bombarded by increasing demands in the quality measurement and patient satisfaction arenas, we've talked to your peers about ideas that work in the real world. (Also, see stories on a new outcomes project from the American Association for Ambulatory Surgery Centers, beginning on p. 91.) Consider their suggestions:
· Track patients after they leave. "Everyone looks at infection rates, hospital transfers, but not how quickly [patients] get back into their normal routine," says Anthony Giamberdino, MD, anesthesiologist at Valley Ambulatory Surgery Center in St. Charles, IL. "In ambulatory, we're not good at keeping track of what happens after they leave the facility. We call the next day, but that's it."
Staff at his facility are gearing up to collect data on patients one or two weeks after they've had some of the most common procedures performed at the center. "We want to know how they did after we sent them home," Giamberdino says. (For details on a program that collects data 30 days postoperatively, see p. 94. For more on collecting information on the functional status of patients, see Same-Day Surgery, June 1996, p. 61.)
· Educate patients before general anesthesia. Patients often have little time between scheduling and the procedure, says Susan V.M. Kleinbeck, RN, PhD, CNOR, perioperative nurse educator at the University of Kansas Medical Center and research assistant professor at the University of Kansas School of Nursing, both in Kansas City.
On top of that, many patients recover at home. Those trends pose great challenges for same-day surgery educators, who must provide information to patients and their at-home caregivers. "Patients have a cognitive deficit post-general-anesthesia," she says. "They don't compute. People who are highly stressed don't compute very well either. Specifically, there's a significant number of people who have signed the discharge papers, gone through `routine' teaching, who don't feel prepared to manage their own physical care at home."
Pre-op teaching is cost-effective, but it remains at the bottom of the list of priorities, Kleinbeck maintains. "The first priority is to get them ready for surgery. Next is anesthesia evaluation. Then you go down the list. In last place is pre-op teaching, if there's time. We've got to stop that."
· Improve patient satisfaction by determining needs of individual patients or patient groups. Assess your patients and determine what they need, suggests Patricia C. Seifert, RN, MSN, CNOR, CRNFA, manager of cardiac surgery at Halifax Medical Center in Daytona Beach, FL. Some patients may have learning needs that will impact the outcome of the surgeon, she says.
For example, a diabetic patient may undergo a breast biopsy, she says. "If the patient doesn't have well-controlled diabetes, the patient education related to the diabetes probably will have a direct impact on the functional recovery of the breast," she says. "Our own particular knowledge, skills, and experience is not now an end to itself. It's a means to achieving patient-related outcomes."
Keep in mind that provider and patient requirements may not match, but both are valid, she says. "I want them to be free of infection, be educated sufficiently so they can identify expectations and potential complications, know what they do if you have symptoms, know the signs they can recognize. I need to know what the patient wants if I'm truly going to meet the needs of the patient."
Post-discharge surveying is important for determining patient needs, she stresses. "The two questions that patients usually responded to and appreciated being asked: One, 'What can we do better?' Two, 'What would you have liked to have known that you didn; was there something that would have helped/speeded up your recovery?'"
Other questions could center on whether the facility was too warm or cold; whether staff and doctors were friendly; and whether questions were answered, Seifert says.
· Be able to interpret information from the Internet. Patients can get vast amounts of information via the Internet. The educator's role is to interpret that information, she says. Misinfor ma tion often complicates the process. To know what's on the Net and to be able to decipher it, you must be computer-literate. "Nurses historically have been translators. We still must be able to translate."
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